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Head Size and Metal-on-Metal Bearings

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Total Hip Arthroplasty

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Abstract

The reintroduction of metal-on-metal (M-M) bearing components in total hip arthroplasty (THA) occurred with small-diameter heads (28–32 mm) in the late 1980s and gave excellent results up to 15 years of follow-up (Dastane et al. 2011; Grübl et al. 2007; Migaud et al. 2011). Shortly thereafter, M-M hip resurfacing (SRA) resurged, and favorable outcomes are currently reported at follow-up exceeding 12 years (Amstutz et al. 2010; Coulter et al. 2012; Treacy et al. 2011). From this rapid overview of the literature on metallic articulations, one may erroneously conclude that bearing diameter has no influence on survival of M-M articulations. Currently, there is growing controversy regarding M-M bearings considering adverse reactions to metallic debris (ARMD) and concerns about blood ion elevation (Engh et al. 2010; Glyn-Jones et al. 2009; Hart et al. 2012; Heneghan et al. 2012). In fact, these side effects were rare at the time small M-M bearings were reintroduced: Rising metallic ion levels in blood were low (Grübl et al. 2007), and aseptic lymphocytic vasculitis-associated lesions (ALVAL) were extremely uncommon (<1/15,000) with small M-M (Willert et al. 2005) while pseudotumors were marginal (1/100,000) (Gruber et al. 2007). Looking back, controversy mainly emerged after large M-M bearings were launched in the late 1990s, particularly after the introduction of large-diameter head (LDH) THA and after dissemination of SRA (Heneghan et al. 2012). The goal of this chapter is to assess if these concerns apply equally to different diameters of M-M articulations.

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Conflict of Interest

Henri Migaud is an occasional consultant to Zimmer and Tornier. Julien Girard is an occasional consultant for education and research to Zimmer, Smith and Nephew and Wright Medical Technology.

Charles Berton, Sophie Putman, Antoine Combes, Alexandre Blairon and Gregory Kern have no conflict of interest to report.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Roger Salengro Hospital, University of Lille, 2 avenue Oscar Lambret, 59037, Lille, France

    Henri Migaud MD, Charles Berton MD, Sophie Putman MD, Antoine Combes MD, Alexandre Blairon MD, Gregory Kern MD & Julien Girard MD, PhD

  2. Department of Sports Medicine, University of Lille 2, Lille, France

    Julien Girard MD, PhD

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  1. Henri Migaud MD
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  2. Charles Berton MD
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  3. Sophie Putman MD
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  4. Antoine Combes MD
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  7. Julien Girard MD, PhD
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Correspondence to Henri Migaud MD .

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  1. Orthopaedic Hospital Vienna-Speising, Speisinger Str. 109, Vienna, 1130, Austria

    Karl Knahr

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Migaud, H. et al. (2013). Head Size and Metal-on-Metal Bearings. In: Knahr, K. (eds) Total Hip Arthroplasty. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35653-7_12

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  • DOI: https://doi.org/10.1007/978-3-642-35653-7_12

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